[Show abstract][Hide abstract] ABSTRACT: The use of cardiopulmonary bypass (CPB) for lung transplantation (LTx) has been reported previously. This study reports the authors' experience of planned and unplanned use of cardiopulmonary bypass for LTx.
A university teaching hospital.
Patients undergoing LTx.
A retrospective analysis of the charts of all patients having undergone LTx over the last 10 years.
Among 140 LTx, 23 (16%) were performed with the use of CPB. CPB was planned in 11 cases and unplanned in the 12 other cases. The use of CPB is associated with a longer period of postoperative mechanical ventilation, more pulmonary edema, more blood transfusion requirement, and an increase in postoperative mortality at 48 hours and 1 month. Surgical difficulties related to the dissection of the native left lung and acute right ventricular failure are the main reasons for unscheduled use of CPB.
Scheduled and unscheduled CPB for LTx are associated with an increased mortality at 1 month and 1 year.
Journal of Cardiothoracic and Vascular Anesthesia 11/2006; 20(5):668-72. · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Quality approach supposes to measure the discrepancies between reality and recommendations. Then corrective actions can be proposed. A good goal for a specific unit could identify only a few fields that should be investigated yearly. This process should involve not only the ICU director and head nurse but also the whole team. The corrective actions must be evaluated and the results shared in the team. A benchmarking approach in comparison with similar units can also be stimulating.
[Show abstract][Hide abstract] ABSTRACT: To assess incidence, outcome, and early predictors of mortality for patients with primary graft failure (PGF) following lung transplantation (LTx), and to develop an injury severity score able to accurately predict ICU mortality for these patients.
Retrospective cohort analysis.
Two LTx centers in Paris.
Two hundred fifty-nine patients who underwent LTx over a 12-year period.
One hundred thirty-one patients (50.6%) met PGF criteria: radiographic graft infiltrate within the first 3 days following LTx associated with gas exchange impairment (PaO(2)/fraction of inspired oxygen ratio < 300 mm Hg). This syndrome was associated with an increased duration of mechanical ventilation (9.1 +/- 1 days vs 3.1 +/- 0.6 days, mean +/- SD; p < 0.001) and ICU mortality (29% vs 10.9%; p < 0.01). The patients with PGF were randomly assigned to developmental (n = 85) and validation (n = 46) samples. Using logistic regression analysis, four variables were found associated with ICU mortality in these patients: age, degree of gas exchange impairment, graft ischemic time, and severe early hemodynamic failure. An ischemia/reperfusion injury severity score was derived using these four variables. Model calibration was good in the developmental and validation samples, as was model discrimination (area under receiver operating characteristic curves, 0.93 and 0.85, respectively).
PGF following LTx is a frequent event, with significant ICU morbidity and mortality. We demonstrate that four simple factors allow prediction of ICU mortality with good accuracy.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the influence of preservation solution type and extra- or intracellular composition on the occurrence of early graft dysfunction after clinical lung transplantation. For 170 patients who underwent a single (n = 124) or bilateral (n = 46) lung transplantation in two centers in Paris between 1988 and 1999, the preservation technique applied to the donor lung was single-flush perfusion of the pulmonary artery with one of several solutions of intracellular (Euro-Collins, n = 61; University of Wisconsin, n = 24) or extracellular composition (Cambridge, n = 64; Celsior, n = 21). The early postoperative outcome of these patients was reviewed. Reimplantation edema occurred in 48% of all patients, and the overall 1-mo survival rate was 84%. No significant difference in the incidence of edema, duration of mechanical ventilation, and 1-mo survival rate was observed between the four groups or between intra- and extracellular groups. After adjustment for graft ischemic time by means of multivariate analysis, the use of extracellular preservation fluid was associated with a lower incidence of reimplantation edema without effect on 1-mo mortality. Graft ischemic time was associated with both edema occurrence and 1-mo survival rate (p = 0.02 and p = 0.01, respectively). We conclude that extracellular-type solutions are associated with better lung preservation than intracellular-type solutions in clinical transplantation.
American Journal of Respiratory and Critical Care Medicine 11/2001; 164(7):1204-8. · 11.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report three cases of volume reduction surgery in three single lung transplant recipients with emphysema. Each patient had a late decline in lung function with hyper-inflation of the native lung. Lung function was improved post-operatively for two patients. The relief of thoracic overdistension may be considered in single lung transplant recipients who exhibit clinical significant functional deterioration.
Revue des Maladies Respiratoires 11/1998; 15(5):665-7. · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the efficacy of the Simplified Acute Physiology Score (SAPS II) in intermediate care units. A number of patients hospitalized in the intensive care unit (ICU) could be hospitalized in alternative structures, intermediate care units, which are equipped to handle their monitoring needs and able to provide adequate treatment at a lower cost. Characterization of the patients relies on the assessment of their severity of illness by severity scores. The efficiency of severity scores has been established in ICU patients, but not in the setting of intermediate care units.
Intermediate care unit of a multidisciplinary hospital.
Four hundred thirty-three patients admitted to the intermediate care unit.
Of 561 consecutive patients admitted to the intermediate care unit during a 12-mo period, 433 patients could be included in the analysis. Patients were admitted from the emergency ward (60.9%). Of the study patients, 60.9% were admitted from the emergency ward for mostly (96%) medical reasons. Average length of stay was 3.1 +/- 2.3 (SD) days. Death rate in the intermediate care unit was 2.7% (n = 11). Average SAPS II was 22.3 +/- 12.0 (range 6 to 73). Hospital death rate was 8.1%, whereas the expected mortality rate derived from SAPS II was 8.7%. To assess the performance of the system, a formal goodness-of-fit test was performed to evaluate calibration. Calibration was accurate using the C coefficient of Hosmer-Lemeshow statistics (C = 2.4; p> 0.5). The discriminant power of SAPS II, measured by the area under the receiver operating characteristic curve was excellent (0.85 +/- 0.04).
The SAPS II assessment of severity of illness in patients admitted to an intermediate care unit is reliable. These results will need to be confirmed, using different patient samplings from intermediate care units.
Critical Care Medicine 08/1998; 26(8):1368-71. · 6.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In spite of improvements in single or double lung transplantation (LT) technique, complications after LT are not uncommon; the most frequent ale anastomotic complications, infections and rejection (acute or chronic). Early detection of complications of LT allows the optimal therapeutic option to be taken, yielding decreased morbidity and mortality. In some cases, CT plays a key role in early detection of several complications of LT that may not be depicted with other diagnostic modalities, so that knowledge of their CT features is important. In this pictorial review, the authors describe the spectrum of CT features of the complications of LT (including reimplantation response, mechanical problems, acute and chronic rejection, infection, lymphoproliferative disorders, recurrence of the initial disease and complications involving the pleura and the anastomotic sites). In addition, the authors analyze the value of CT compared to that of the other available modalities for the detection of complications of LT.
European Radiology 02/1997; 7(6):847-53. · 3.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The efficiency of severity scores and therapeutic indices has not been established in the setting of Intermediate Care Units. The aim of the study was to assess the efficiency of SAPS II and Intermediate TISS in an Intermediate Care Unit. A prospective study was performed from June 1994 to June 1995. 561 patients were studied (average age 51 ± 20). Most of the patients were admitted from the emergency department (60,9%). Reason for admission was mostly medical (96%). Average length of stay was 3,1 ± 2,3 days. Average SAPS II was 22,3 ± 12,0 (6 to 73). Hospital death rate was 8,1% whereas the average probability of mortality was 8,7%. The discriminant power of SAPS II, measured by the area under the receiver operating characteristic curve, was excellent (AUC 0,85 ± 0,04). The calibration was good (Hosmer Lemeshow). The average I. TISS was 14,3 (5 to 37). I. TISS was shown correlated to the patient's severity as measured by SAPS II (p = 0,0001). Assessment of severity of illness in patients admitted in an Intermediate Care Unit by SAPS II is reliable. Intermediate TISS was shown efficient in describing therapeutic activity and was correlated to the patient's severity. A confirmation of these results in Intermediate Care Units of different case mix is required.